MEDICAL SURFARI: GASTRONOMIC CONSEQUENCES

Almost everyone at one time or another has experienced a little "heartburn", particularly after meals. Often people explain this away describing it as "indigestion" or describing the food as "something that just doesn't agree with me." But, in fact, the "heartburn" is often the result of acid escaping from the stomach into the lower esophagus (swallowing tube connecting the mouth to the stomach).

After each meal the food in the stomach stimulates the production of a strong hydrochloric acid that that promotes the digestion and prepares the nutrients for optimal absorption in the small intestine.

Once food has passed from the mouth through the esophagus and into the stomach the lower esophageal sphincter (LES), a muscular ring, closes the opening of the esophagus into the stomach. Overeating or over distention of the stomach may cause this to incompletely close and certain foods cause the LES to relax or close less tightly, which may allow acid to reflux up into the lower part of the esophagus.

When the lower esophagus is irritated by strong hydrochloric acid this may in turn stimulate a contraction of the muscle in the esophagus normally responsible for pushing the food from the lower esophagus into the stomach and this contraction returns approximately 90 percent of the acid and food back to the stomach. Once the contraction ends, the LES closes again and the remaining acid in the lower esophagus is neutralized by the successive swallows of saliva, which is alkaline.

"Heartburn" is the burning sensation or discomfort behind the breastbone or sternum and it is the most common symptom of acid reflux, which is sometimes referred to as gastroesophageal reflux disease (GERD). If this occurs on a chronic basis there may be complications including erosion of the esophagus resulting in an esophageal ulcer. Multiple eroded and scarred areas may result in a stricture or significant narrowing of the esophagus, which may result in difficulty swallowing. There are also pulmonary manifestations such as asthma, coughing or intermittent wheezing and vocal cord inflammation with hoarseness as sometimes the gastric acid ascends to the level of the throat resulting in irritation of these tissues.

GERD can be due to a variety of gastrointestinal problems such as delayed stomach emptying, ineffective esophageal clearance and diminished saliva as well as a weak LES. Some medications, foods or other products may worsen the symptoms of GERD in some patients. It is relatively well known that tobacco, caffeine, chocolate, fatty foods and overeating as well as tight clothing and the presence of a hiatal hernia may worsen the symptoms of GERD.

The treatment of GERD sometimes simply requires some lifestyle modifications, but in other cases it requires the avoidance of certain types of food that may adversely affect the LES. Some patients are treated with antacids and alginic acids and others are treated with prokinetic medications that help to promote the timely emptying of the stomach into the small intestine.

In most cases your family doctor can effectively diagnose and treat GERD.

World Wide Web Resources

National Digestive Diseases Information Clearinghouse www.niddk.hih.gov/health/digest/pubs/heartbrn/heartbrn.htm The National Digestive Diseases Information Clearinghouse is part of the National Institutes of Health. This clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public.

GERD Resource Center

www.gerd.com.com/intro/noframe/grossovw.htm This site has a very thorough discussion of GERD that would be helpful to anyone with symptoms of the disease.